If you pay attention to the press releases, the Congressional Budget Office’s new estimate of the health reform law is either proof that the health care law will reduce the deficit—or proof that it will increase the cost of health care. In other words, it’s the same health care debate politicians have been having since the Affordable Care Act passed in 2010.

The CBO offered a fresh analysis of the 10-year cost of the health care law on Tuesday in the wake of the Supreme Court's ruling that states could opt out of expanding Medicaid to low-income adult populations without losing all of their other federal Medicaid funds. The congressional analysts found that the health care law is $84 billion cheaper and that 4 million fewer Americans will get health insurance, as states opt not to expand their Medicaid programs.

“Politically, it’s a wash on both sides. From a public-policy perspective, it’s very complicated,” said Julius Hobson, a lobbyist for Polsinelli Shughart who used to head up the American Medical Association’s lobbying shop. “I just don’t know how either side can stand up and say, ‘We got everything we wanted.’ Just like in the Supreme Court decision, it didn’t work out that way.”